Friday, November 28, 2008

Allison's Birth: Braver than you believe, and stronger than you seem

As a doula and a Certified Professional Midwife’s apprentice I see all kinds of births and they are all special. But some of them are just extra special… Births that I know I’ll never forget.

Such was the case with Allison. Her birth happened recently, but I think I’ll remember it for the rest of my life.

When I met Allison at the midwife’s house for her first prenatal, her happy, easy-going ways immediately made me think that she would be a fun client to work with. Her bleached blonde hair, perfect tan, and French manicure made me wonder for just a second if she would find it difficult to just “let go” when labor happened. Would she be able to listen to her body, make the sounds that she needed to make, and assume the positions that she needed to when it came time to birth a baby? Would she be worrying about her makeup or simply focus inward and do what needed to be done? How would she do without any kind of pain medication at home?

She and her husband were totally confident that they could and would do this birth naturally just fine, and had no concerns. They didn't know anyone who had ever had a homebirth, but they were so excited about planning their birth. Her husband was a respiratory therapist and had worked in the medical field for years. Their midwife asked, “So why do you want to do a homebirth? After all, your insurance would even cover your birth in hospital, right?”

Rick and Allison looked at each other and smiled. “We’ve known for years that we would never have our baby in the hospital unless we had to! Rick has seen too much stuff there, and my mom is a labor and delivery nurse there and she’s always telling us stories. We would just rather stay home and have one on one care with someone who knows us as more than a patient number for their shift. We want somebody that knows US and what we want and what my health has been like….”

****

When Allison was about a week overdue, I got a call: "Allison's in labor. Her water just broke, but she’s not really having any contractions right now.”

As I was driving to Allison’s house, her midwife called me to update me on the latest.

Allison had come to see her over the weekend because she wasn’t sure if she was in early labor or not with mild contractions.

”I learned some things about her pelvis that I wasn’t aware of before…” Joanne said, a hint of worry creeping into her voice. And then she said it: “I just don’t think her pelvis is big enough for any baby to fit through!”

I was a little shocked, because it had never come up as an issue at any of the prenatals with Joanne that I had been present for.

Joanne explained that she had not done any kind of vaginal exams early in pregnancy at Allison’s request. She had done Allison’s first vaginal exam when Allison and Rick had come over, wondering if she was dilating. And Allison had never seemed like the kind of person who would have a pelvic issue. She wasn’t petite and seemed to have a very average frame.

Joanne had NEVER worried about anyone else's pelvis during any of the births I had ever assisted her with. Sure, some women had to push longer and harder to get their babies out, but they usually always succeeded in birthing their babies vaginally. CPD had seemed basically non-existent in Joanne’s practice. Until today.

She thought that the inlet and mid-pelvis was adequate. With Allison, it was the outlet (nearest the perineum) that felt so tight during the vaginal exam.

We pulled up at Rick and Allison’s home and there she was - happy and walking around excitedly in early labor. Joanne did a check for dilation (2 cm.) and then said, "Can Mary check you, too? She needs some more practice."

Allison didn't mind, except that every time anyone inserted two fingers (ever so gently and slowly when she was comfortable) to check, she would totally screw up her face and clench her pillow and say, "Owwwww! My tailbone hurts SOOO bad!" That seemed kind of odd. Her midwife commented that her tailbone had been that sore the day before, too when she had done the first exam.

Then Joanne told Rick and Allison that we were going out to breakfast to give them a bit of quiet resting time to themselves in early labor. They liked that idea, and we left.

As soon as we drove away, Joanne turned to me and said, "Did you feel what I'm talking about with her pelvis?! I wanted you to feel that. That’s why I asked if you could check, too."

I exclaimed, "Did I ever! I'm thinking the exact same thing you are. HOW is a baby going to fit through THERE?!"

When I had checked Allison, it seemed as though the very outlet of her pelvis where the base of my fingers rested barely had room for more than three of my fingers. Joanne said that she estimated at the widest part, her pelvic outlet seemed to be not more than 6 cm (that's bone, plus think flesh, then try to get a space 10 cm wide and get a head through there!).

Joanne told me that Allison's horribly sore pelvis seemed to confirm to her that her pelvis was, even though tiny, doing it's best to expand for labor.

As we drove on, Joanne sighed. "I don't think she's going to get this baby out no matter how long she pushes, but if she DOES, I think she's going to break her tailbone. This is probably one of those cases of true CPD, and I feel so bad for her because the reality of a C-section hasn't even crossed her mind."

I asked her what she had told Allison about her pelvis. She told me that she had only told her half the truth when she checked her the day before, saying, "You seem to have a marginal pelvis, and I think you are going to have to work harder than most people to get a baby out. But I think you can do it."

Joanne added, "I’m really not very sure about the thinking she can do it part, but we can only wait and see what happens when she starts pushing."

We went back to the house after breakfast, and Allison was munching on a granola bar and doing hula stuff with her hips and walking and swaying constantly. It looked like she had been to a belly dance class.

She did that all day long. She never stopped moving. She constantly paced, and swayed, and swiveled her hips and sat rocking on the birth ball. A couple of times, her midwife and I begged her to rest for five minutes, knowing she had a long, exhausting journey ahead once she started pushing.

Every time she got into a new position for a contraction, if it was more uncomfortable that way, she'd say, "Ooooh! This really hurts!"

We'd look at her and say, "Well, you can try something else... You don’t have to hurt yourself more!"

But throughout her entire labor her response every single time was, "No, this feels like it's opening me up and I want to bring it on! The more intense, the better! More, baby! Ooooh! Owie! This is powerful stuff!" She put herself in the most uncomfortable positions because she thought it would help her move things along. What could we say? We were impressed with her strength and determination. We just hoped that somehow she could and would birth this baby. She would be crushed if a c-section became necessary. But we kept our thoughts to ourselves.

As labor progressed through the afternoon, she became deeply focused between contractions (instead of watching a movie, talking, eating). Allison started to do all sorts of things that had her midwife and I exchanging some strange glances.She looked like she was doing an instructional video for the The Labor Progress Handbook! We knew that she had never read any doula or labor progress books or seen these positions anywhere, so our mouths dropped open as she proceeded to do things like the double hip squeeze (pressing in on the top of the pelvis with a contraction, widening the outlet), the lunge and then she went into doing the lungewith one foot up on a chair and a huge, low, wide, squat with every contraction for hours. She'd hang on her husband and go lower and lower and wider and wider, saying, "Owwiee! This is wooorking!"

It would have been fun to try to keep up with charting her postions - she must have done at least twenty different ones, with no guidance from us! She would do something, and then say, "Is this okay? Should I do something else?"

We kept telling her that she looked like she was doing every position for opening the pelvis that we'd ever seen in a book and it looked like her body was telling her exactly what to do.

She'd smile and say, "Well, it hurts, but I want to do it. It just feels right." She was amazingly in touch with her body and so instinctual about everything she did!

By 5 pm that night, she was almost 10 cm, but because of the tight fit of baby's head and the pelvis, the anterior part of the cervix was getting "dragged down" with the head as the baby descended. The lip of the cervix that was in front of the head and under the pubic bone was starting to swell. The baby was descending, but stretching the anterior cervix along with it. It was such a tight fit in there that her midwife wasn’t even sure how to move the cervix back above the head. Finally, around 6 pm Joanne started trying to hold it back, from being shoved down any farther. She let Allison start pushing; trying to get the head past the cervix, hoping it would soon stay behind the head. But, because it was so tight in there, Joanne had an extremely difficult time holding it back. (Her fingers would get compressed between head and pubic bone, and baby started to mold around her fingers!)

Allison pushed and pushed and pushed (mostly on a birthing stool with her husband sitting behind her, encircling her with his arms and her gripping his knees.). At 8 pm, she finally got the head past the cervix.

The baby's heart rate sounded wonderful throughout pushing, so she just kept going and going and going.

We weren't "directing" her pushing, just telling her what a great job she was doing, but she voluntarily did the "purple pushing" like people are often coached to do in the hospital for four and a half hours! I've never seen anyone do that at home without being "forced" to. I guess she knew what she needed! Joanne and I watched in amazement as she pushed and pushed and pushed. Her face was red and purple and the sweat poured off her. This beautiful lady was working harder than we had ever seen anyone work! In spite of dissolving into sobs between contractions at the sheer frustration and hardness of what she was doing, she never said, “I can’t do this!” She seemed to have an iron will to get her baby through her pelvis.

And her baby’s heart rate never showed any sign of stress. Who were we to say that she couldn’t do it?

At 10:00 pm, we started to see head. And at 10:30 pm, we had a little 6 ½ pound baby boy with a very tiny, very coned head and a woman who had just become a mother, absolutely beside herself that SHE DID IT!

So much for a woman with a literal 6 cm diameter pelvic opening!

She did it anyway!

So much for a woman who seemed impossibly tiny to birth a baby!

She did it anyway!

Less then three minutes after she finished those four and half grueling hours of pushing, she caught her breath, looked at her little boy and said, "You're so worth every bit of work I just did to get you here!"

I

glanced over at Joanne and saw tears glistening in her eyes. I knew that she had to be just as proud as I was of this woman who had showed us that women are braver than they believe and stronger than they seem!

27 comments:

As a mom that was told at my first prenatal (by the OB) I was to small and would need a c-section...and then went on to birth a 10 lb baby at home.....I love hearing these wonderful stories. Thank you for sharing!

Way to go Allison! It is so awesome that mom and baby made it through such a long round of pushing... I've never heard of anything like that happening in a hospital (at least not since C-sections became so commonplace). Thanks for sharing such an empowering story.

Hooray! I love this story! As a mom who VBAC'd a 10 lb baby after the doctor insisted he needed to section me because I'd never dilate past 5 cm - I am APPLAUDING this woman. Thank goodness for her labor support who never tried to tell her that her body wouldn't do it's job.

Amazing. Thank you for sharing the story. I wish my first birth wasn't induced; it ended in an emergency C-section. My second birth was, thank the Lord, a successful VBAC. Tried getting to the hospital as late as possible, so I wouldn't be forced to lay on my back for as much of the labor as possible. Wish I had the courage to have the baby at home. We'll see, if we decide to try for another baby.

How sadistic. This is WAY too primitive for me. Get me to the hospital, pump me full of drugs and get the kid out. You've gained nothing by torturing yourself, except a grisly story you can tell later on. What if the kid got stuck and she needed a section real fast? Doesn't sound like a responsible thing to do as far as I'm concerned. Look at all the humanity around you. Can you tell who was born naturally and who came into the world with mom blissfully unaware of pain? What's the point?

What a fantastic story. This is true inspiration. I am so glad the midwife never scared Allison, and just gave her the chance to do what she needed to do. This is a real positive story about trusting birth and trusting mothers to follow their instincts. It's refreshing, really.

I pushed a full 5 hours at home with my first baby... and 3.5 with my second baby... so I can totally relate to the determination that this woman exhibited! I remember going into that stage where I was embracing the pain and realizing that I HAD to do it no matter what. It was nearly overwhelming, but it's truly amazing what a laboring woman will endure when she has her heart and mind set on having her baby at home!

This is a fantastic story and to Anonymous...I'm guessing you've never given birth because the idea that a drugged birth is blissfully, unaware of pain is false. I often watch women who have chosen drugs suffer more.

flowers, I can only go by my own experience. with both my boys I had the drugs, not a whole lot of pain involved.....I've been wathcing this blog since I posted last March, waiting for somebody to challenge me, surprised it took so long.

Blog author: Thank you so much for sharing this. I had my first by c/s and my second by home VBAC. The difference is night and day. The peace, the immediate attachment that was sadly lacking the first time. The feeling of worthiness. My husband and I have vowed to never have another in the hospital unless medically (and I mean per midwife definition) necessary. There are those who see birthing as a medical necessity, and they are poorer in this world for it. Then there are those of us who have realised something better. Something that allows our bodies to do what they were meant to do without medical intervention unless necessary. In a hospital she surely would have had a c/s. Then what? What of the loss of bonding, the chance of infection, the abruptness to her newborn coming into that environment? What of the harmed bf relationship and the greater chance of PPD? To Anon I say: I'm glad you got the births you wanted, now allow us the liberty of ours. Don't mock what you don't understand, what you don't value, and what you've never experienced.

This is anonymous again. Yes, I'm still watching this blog. Not go to a hospital? What if there are complications with the baby? What kind of medical equipment do you have in your home? A rectal thermometer? Have your babies at home. By all means, have the "liberty" of tearing from your vagina to your anus, I guess that's your choice. I'm sure you'll never post this, but at least I've had my say. Nice move changing to "comment moderation". Now you can choose to only post these sappy, dripping with drama, "I pushed 24 hrs at home" sagas.

About Me

I am passionate about making every birth the best it can be for every woman and her baby, whether that be hospital, birth center, or home.
I believe the first step to better birth is women who are better educated... about their bodies, their incredible abilities, their choices, and the joy of motherhood.
I have been a birth activist and hospital doula for years, and now proudly claim the title of Certified Professional Midwife as well, serving women who choose homebirth.

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Disclaimer

Each of us is responsible for our own health and well being. The information and recommendations on this blog are not medical advice.The blog posts are based on the knowledge, research, and experiences of the blog author and owner. Each mother, baby and pregnancy are unique, and the blog author can assume no liability for the use of the information published on this blog. All blog readers are encouraged to do their own research and to seek appropriate medical consultation and care whenever indicated.It is a sign of wisdom, not cowardice, to seek a second or third opinion.

The suggestions in the comments section have not been endorsed or recommended by the blog author in any way.

Details have been changed to protect the identity of clients in birth stories I tell, in accordance with HIPPA regulations.

All material on this blog is copyrighted and may not be used, reprinted, etc., without permission of the blog owner.(c) 2008 Mary Ueland